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tv   Q A  CSPAN  August 30, 2009 11:00pm-12:00am EDT

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of the virginia hospital center, do you remember the first time you wanted to be a doctor? >> i think so, my stepfather was a surgeon, i wanted to be like my stepfather. from age seven, when we came into my life, i wanted to copy him. it got more serious in high school, i dislocated my hip from a skiing accident. and had to be in a hospital with a pin in my knee and traction, and had a lot of time to lay up and observe people, and i think i decided then i was going to do it. >> where did you grow up? >> i grew up in alabama. >> where did you go to college? >> i went to embrae university for undergraduate, and medical school at university of
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alabama, in birmingham. >> when did you heart part of this get in your life? >> the medical school at alabama had a strong cardiac surgery program, lead by a man named john kirkland, that's one of the world's greatest cardiac surgeons. and cardiac surgery was highly visible even to medical students. and that's where i saw heart surgery for the first time. and then in surgery training, i did an internship, and one thing that i rotated through was cardiar surgery. and dr. kirkland was my mentor, it was a brutal six weeks, very little sleep and hard work. but when you finished it, you felt like you had been through
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marine boot camp. and i remember that dr. kirkland had put his arm around my shoulder, and said, you should consider doing this. and from that moment on, and even though my stepfather was a foot surgeon, after that i was cardiac all the way. >> when was the first time that you opened the chest, and where was it? when was it? you are on your own, you are your boss. >> it takes a long time to be a surgeon, and orit takes longer be a heart surgeon. i don't wake up one day and do it, you do parts it of. and from the time in alabama as an intern, i did parts of heart operations. there is thousands of different steps in any operation.
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and in cardiac surgery you would do one part. and then over time you would have done a whole operation, but never the whole operation yourself. and so it was only when i went to houston, texas, to train in cardiac surgery with another notable famous man named denton coolie, it was there after half of a year, that i was left alone to do a cardiac operation. and i remember then, by that time i was an experienced surgeon. i knew how to operate. but it was still an unforgettable thrill to be in charge of that patient. >> have you ever done a heart transplant? >> yes. >> what is that like? >> it's -- i think it's, most people think it's more glamorous than it really is.
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for me the beauty of a heart transplant is seeing a desperately ill patient who looks sick and looks like he's dying. and you put the heart in him, and the technical part is not difficult, and the big stitches that you put, the big suture lines, and instantly, by the next morning the patient has a different look. and that's the most thrilling thing about that, that it just takes no time at all for the patient to look just magnitudes better. >> are you ever frightened in the middle of an operation? >> no, i don't think frightening is the right term. sometimes after an operation, i will think, what could have happened or why didn't
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something happen. and that sort of after the fact might get scared of what the consequences could have been. sometimes during really desperate sorts of operations, where it really is life or death, i mean you are just so focused in what you are doing.i you don't really, you don't think about the consequences. >> what is the longest you have ever been on your feet in the operating room? >> probably a little over 24 hours. >> doing what? >> we were doing a patient who had torn their aorta. the big artery that comes out of the heart. and i was working with one of my partners. and it took, the patient bled and we couldn't stop the
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bleeding. and i think if there had been one of us there, not together, you know we might have stopped. but we were there together. and we were in our program here, and the nurses still talk about it, because the shifts changed and we didn't. and they talked about us both sitting on little stools by the operating table. dozing off, waiting for this patient, we wouldn't give up. and the patient eventually stopped bleeding, and walked out of the hospital. and was well. >> i know you won't name the person, or well, i will ask the question. the most difficult patient situation you have ever had that you can think of? >> ok. i have it. >> go. >> it's a great story.
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it's been years ago, but i was operating on a priest. and i had just begun taking the vein out of the priest's leg in the operating room. i was by myself. and one of the general surgeons came in the room and said, i really need your help. we have a young lady that has had an appendectomy, her appendix removed. but she's had cardiac arrest, her heart has stopped, and we are not sure what is wrong with her. she's about 28 years old. and i broke scrub and went over and looked. it was a young girl and i thought she had a big blood clot to her lung. i quickly ran through the different possibilities of what i could do. and because, a little bit of
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because who the patient was, i made the decision to move the parity -- patient out of the operating room, and move her into the operating room. and i opened her chest, emergently, and opened the artery where i thought the blood clot was, and it wasn't there. so there i was with a patient i had moved out, and this patient i had made the wrong call on. so then i started feeling around her heart and she had some blockages, i could feel in her coronaries. so blindly, which is again very substandard, i did three bypasses into these blocked arteries. and she came off the heart/lung machine with a little difficulty. but the next day, later that
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day i woke the priest up and said, we got some good news and bad news for you. but the good news is you saved another ladies' life, and the bad news is that we didn't do your operation today. the end of that story is that that girl lived and a beautiful girl. and it was a great story, she became friends with the priest. and he felt very much involved with her situation. we ended up cather later, you usually cath patients before bypass surgery. >> what does yjthat mean? >> you insert dye and see what blockages are in the arteries, we did that after i bypassed her. i could only feel hardened
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areas on her heart, indicating blockages. and as it turned out the graphs i did -- grafts i did were the ones she needed. i think she got just what she needed. but it was not the standard way that you get that. >> when patients come to you, what can you almost always predict they are going to do when you start to talk about their condition? >> you know, more than you think, at least in cardiac surgery, patients they really have a high degree of trust for you. and a lot of patients don't want to know a lot of detail. i think it's pretty different in cardiac surgery and other specialties. although more and more patients
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will have been on the internet, reading and learning things. but so many patients just want you to do what you do, and are grateful for it. they don't need to know a lot of details. they are interested when they can go back to work. they are interested in the likelihood of them dying. but a lot of the other details, i think they are not too interested in. so it really puts a burden on us, there are certain things you need to know. and we try to tell patients those things. even if they are not too interested. >> so you are in the operating room, say you are doing a bypass surgery, how many people are in there and what do they all do? >> well, before i answer that, the team in heart surgery is
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critical. i have been blessed with a team that we have been together for 20 years, and there has been very little turnover, you learn each other, it's like family. but there is an anesthesiologist that's a doctor and puts the patient to sleep, and manages the drugs. and he's got a helper. and i have an assistant and i operator operate with a nurse, and i have three people, and i have an r.n.first assistant, i am more comfortable with them, because i have their total attention and they know exactly what my routines are. they are nurses, and they are
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extremely skilled nurses. next to me, the person who passes my instruments is called a scrub. and in kfcardiac surgery, we usually have one other person at the table, who is called the second assistant, who holds back the heart so i can see where i need to operate. and in the room is a person called a circutor, and that's another nurse who is the person who gets you the things that you need. if you need another stitch or another instrument that's not there, that person gets that. so that's pretty much a standard open heart team. which is bigger than a typical team in a typical operating room. >> you said you have done this here for 20 years at the virginia hospital center. >> yeah. >> did you come here in 1989?
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>> di. -- i did. >> from where? >> i finished my cardiac training in houston in 2006. >> 2006? >> excuse me, 1986. >> yeah. >> you know heart surgery you can't go somewhere and do heart operations. it takes a hospital that will give you the equipment and the team you need it takes a lot of resources. one of my dear friends started a program in alabama, we were there two years, and brought nurses from birmingham and i brought a staff from houston. and we start this program there , and during that time there, the hospital here began plans
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to have open heart surgery here. and they went on a national effort to recruit surgeons. and we were included in that. and we came up and looked at the facility, and the city. you know i had always wanted to live in washington. but in '86 there was no opportunity for me to come here. and this gave me an opportunity, and we left on good terms in alabama, and came here in 1989. >> why did you want to live here? >> well, it was washington. there's a lot going on here, and i am into food and my wife into culture. we weren't too happy in alabama. we wanted to raise our family
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in this area. >> where did you meet your wife? >> my wife was -- i was a chief resident in surgery, and one of the medical students was on my service. and her best friend was my wife, mary. and mary, we had a blind date. fdays i drove a little beat-up car, a volkswagon, with holes in the floor, and all the girls i went out with spent the first 15 minutes complaining about the car. and mary got in the car and didn't notice the holes, and that's what i like about her still. >> what does mary do today? >> she's a pediatrician here on campus. >> so you work in the same building? >> we do. >> now there is a big
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difference between being a pediatrician and a heart surgeon. >> yes, there is a big difference. >> first i would suspect that there is a difference in what you maybe. -- what you make. >> yeah, pediatricians are not well paid. it would astound you what a pediatrician makes. you know if you consider the amount of training, and the expense they incur to get where they go. >> for the last 11 years you have been chairman of the board of trustees, at this hospital. this is a community hospital. is it non-profit? and if so, why? >> we are a not-for-profit hospital. and if i could, let me take a minute and describe what that
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means. not-for-profit hospital doesn't mean we don't make mobby. -- money. we have to make money. but it means we don't have shareholders, we are not responsible to anybody but our community. we are a 501 c-3 organization, tax exempt.c@ and basically what we do here is we try to either break-even or have a small margin of profit. last year we had a 1.6% margin. all right, so what we do with that profit, is we invest it back into equipment. you know we try to have the latest and greatest that medical science has to offer. two years ago we purchased $7
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million cyberknife, that's a very specialized piece of radiation treatment, but that's what we do with our money. we don't give it out to shareholders. but it's not to say we don't need to make income. we employee a lot of people. and this is not charity. >> gross revenues for a year? >> about $288 million. >> how many people work here? >> a couple of thousand. >> how many of those are doctors? >> we got about 300 on our active medical staff. but now, only a handful of those doctors are employed by the hospital. so most of the medical staff here is an independent medical staff.
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>> there is noise in the background now, do you know what that is? >> it's some sort of alarm. and i don't know what it is, because i don't work here. >> this is where in the hospital? >> this is in the emergency room, and this is what is called the fast-track part of the e.r. so if you come in and hear the disaster stories about coming and waiting. this a part of our e.r. where we try avoid that. we try to get you in? -- in and out without waiting so long. but i don't know what that alarm is. >> we will stop, it's not annoying us to but the to audience. there it stopped. why did you take on the job of chairman of the board? >>
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and how much time in your day do you spend doing that job? >> well, i took it on because it was something else that i could do. you know i sort of worked my way up through leadership, you know here in the hospital. and then i got on the hospital board, and i felt like i was made some reasonable contributions but i didn't feel any that i had sort of special ability? the previous chairman, a man by the name of pat heely, you know when he went off, he encouraged me to run for the chairmanship. and i didn't think that i had much to offer.l/ but you know i did, and i was
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elected, you know i have grown in the job over the years. i think that you know, i work here. my office is here. i am here a lot. and so i do spend time everyday, with chairman sorts of things. but i think probably the one thing i have done is to provide vision for excellence. in clinical care, in the programs that we have developed here. an example would be for the neurosurgery program, my cardiac surgery program, the nationally accredited center for breast health.
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these are programs that we have had the vision to bring forward. in the hospital that we have built, you know we have -- we offer all private rooms to patients. regardless of their ability to pay. >> why? >> because we could, it's the best thing for the patient. you awyknow years ago you could stay in a hospital for five days with pneumonia and it wasn't so bad sharing a room with someone. nowadays, if you are in the hospital, you are sick. otherwise you are out, you are discharged. i think it's unacceptable to share a room in this age with another sick person. it's better for the patient to have a private room. that's the main reason we did
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it, and that's the main thing we pushed, to do the best thing for the patient. >> you have 320 rooms? >> i think we have 3 50 something. >> i was reading the letter. we came here and asked to you do this, because a lot of us use this hospital, we live in the area. a lot of employees and government workers and members of congress and all that. as you sit and listen to the debate over health care, what is the first things you would like to tell somebody that they don't know really what they are talking about? >> oh, well i guess everyone knows it's complicated. ok, for starters, you know the hospital, about half of what we do here is medicare and medicaid. so about half of our admissions
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in our hospital, medicare and medicaid. we lose money on all medicare and medicaid patients. medicare and medicaid covers at best, about 80% of the costs, not the charges, but the cost. so the thing that i guess i want to tell people is that so far what we have seen is the government's, the way the government controls cost is they just pay you less. and we take that. we accept that. but we would have to change what we do if not for the private insurance carriers. whom we aggressively negotiate with to get rates that are 140% of medicare.
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because we are able to do that, we are able to make 1.5% margin so we can buy a cyberknife for $7 million. >> let me stop and ask you, our company has full insurance, so we are paying to make up the difference between medicare and what it costs? >> yeah, you do. your insurance does, right. if we didn't get that extra money if your company, if all we got is what medicare paid, then do the math. we lose 20%. well, we are a business, we can't lose money. so we either go out of business or offer less. so that we can break even. well offering less in health care means that we don't give you the latest and greatest. which you know is not as good.
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>> who sets the cost? in other words you say -- let me ask you this, if you do a heart bypass, what does that cost? >> well, there are two different -- let me tell you how it works. doctors charge separately than the hospital. so if i do a medicare operation, medicare coronary bypass surgery, i accept what medicare pays me. ñ >> it's about $2,000. >> and what do you do for $2,000? what is the total amount of your time spent doing? >> well, surgeons are paid globally. so if i operate on you, i get one payment. and you and i are married. ok, for that month or until i
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get you well, that's what i get paid. so i can see you 10 times a day, i can, you know if you have complications, come in the middle of the night, do whatever it is. i get that one payment. ok. and for the hospital it's similar, they get what is called a d.r.g. payment, and dia for bypass surgery, i think it's about $18,000 that the hospital would get from medicare. to pay for whatever happens to that patient. >> that's the total cost of $20,000 for a bypass that medicare will pay? >> yeah. >> what does it really cost? >> well, it costs more than that, i am not sure exactly how much more. my -- we are way beyond what we
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charge. what we charge and what we collect is totally different. >> but at that point, if medicare is going to pay $20,000, who determines what the insurance company will pay? >> we negotiate with the insurance company. >> do they negotiate off the medicare price? >> absolutely, that's part of the rub, we feel that's an unfair floor, medicare sets the rate and everyone wants to go there.p;% but we lose money with the floor rate that medicare sets. >> how does medicare set the rate? >> i don't know. >> you have no idea? >> no, i don't. >> is that frustrating for you? >> sort of pass that, it's law.
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but it's different than it used to be. >> what did it used to be? [voice over p.a. system]: anesthesia and respiratory therapy, stat to room 738. >> we are in a hospital. >> yeah, and even if you were deaf, you could hear that. >> go ahead. >> there used to be more v7mon in the system. >> why? >> i think that it was -- i mean, look, medical care gets better and better every year. ok, new technology. it's expensive. but it's better and better. things used to be cheaper. but, you know, we are of the mind that there is nothing that is too expensive. we want the latest and greatest. willing to pay for it. and we have.
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but that occurs at the same time, and parallel that we're getting paid less. the hospital is getting paid less. >> every year? >> absolutely. >> why? >> well, that's part of what medicare has the ability to do, to lower what they pay you. and we have nothing to say about that. you know, physician fees, every year they threaten 10% decrease in our reimbursement. and for the last several years, they don't do it and we have a sigh of relief. >> and how much are you motivated by money? >> i am not. [voice over p.a. system]: code blue, 7 b, room 738. >> now that's a little more
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startling than the last announcement. >> yeah. you rhknow most doctors, most doctors truly did not go into medicine to make a big income. i think at least there are physicians in my generation were attracted to medicine by what you can do for people. and the idea you could be independent, to work for yourself. sort of be your own person. [voice over p.a. system]: code blue, 7 b, room 738. >> dr. çñgarret, we were interrupted. code blue, what does that mean? >> code blue is when someone has cardiac arrest, and a team in the hospital resends upon that patient feto recessitate
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them. >> would you do that? >> no, anesthesia and we have resident staffs from the universities. and they sort of lead the team. this is a daily occurrence in a hospital. and you know it brings up a point, this is what we do in a hospital. is our default is to help. it's to save people. and in doing that, we don't think about the money. we don't. it's the last thing on a physician's mind is what money we are spending to bring someone back. and i think that illustrates a very important point, it's not part of what a doctor does. >> but we have been hearing and in another conversation we talked about this, some younger
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people coming into the business have a different attitude about money and their time, than say people your age. >> yeah, it's clearly different. and i think the reasons are justified. but i think that young physicians see a different horizon than the guys and girls in my era. >> what is their horizon? >> i think they are much more protective of their private time. i think they are much more eager to be employed. and not have the responsibility to run their practice. i think part of that is because it's hard, the opportunity to hang out your own shingle now is very difficult. it's too expensive, you can't afford it. and so, you know, young people don't want to take that risk. and there is more of a shift mentality.
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you know in my group, we of never get away from it. even on our nights off, you are still on edge. it's what you do, it's part of your life. and with the newer generations of physicians, you work your shift. there are long hours, but at the end of things you are really off, and you have your life. that is what it is. >> back to my original question to you, what do you want to say in this debate that you think is not being heard? what else? >> let me just make a point about tort reform. >> explain what that is. >> well, you know in everything that we do as physicians and as a hospital, we have a possibility of being sued.
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by patients or family or whatever. and it's not something that is like in the front of your mind. but it's almost engrained in you. and it has unintended consequences. i will give you a really pertinent example that honestly just happened this week. i had an 86-year-old chronically ill man, it's my patient. he came in the emergency room and had a ruptured aneurysm, so a big artery in his abdomen popped. he was still alive, and he had recent abdominal surgery, and his pressure was about 60, he was dying. and i had absolutely no problem
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saying this patient is too sick to have emergency surgery. he's not going to survive. all right. we have new technology, new expensive technology called stint grafts, these are grafts placed inside of the arteries in the groin. but we have that capability. because we have that capability, i sent this patient who normally i would have said, let's stop. down to radiology, they quickly shoot some studies. they called me and said, we can do this, we can save him. but if we save him, he will lose his kidneys, we are sure of that. now, if i did not have the family that i could talk to at that point, i would have said, go ahead. that would have committed that
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86-year-old man to dialysis, and he probably would have died within a month. all right. but i would have been afraid to not proceed on the fear of what if the family really wanted to go ahead, and said, you could have saved him. which we could have, and we didn't. fortunately i had a family who understood everything and elected to stop. but my point is if the family had not been available, we would have done what we do. which is to take the next step, which allot of times is easier than saying stop. and that drives up the cost of health care. >> i understand we are in the middle of the fast-track room for the emergency room, and
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it's in this place you have a lot of defensive medicine, based on tort reform and based on wanting to cover yourself, can you explain that? >> a lot of people that come into the emergency rooms don't want to be there. ok. they didn't plan to be there. it's not like you have a relationship with me, you picked me as why -- me as your doctor. an emergency room, you come in and you don't want to be there, you don't know anybody. if it's a bad situation, there is lots of things going on, things can drop through the cracks without tight protocols. and sometimes more things are done, kind of like what we call a shot-gun approach. it's easier to do just everything, so you don't leave anything out, than to pick and choose.
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and that drives up costs. >> go back to your mention of something called a cyberknife. $7 million machine, the first one in georgetown hospital, is this the first in northern virginia? >> it is. >> how much do you pay for that , and how much is controlling the cost. you have a $7 million machine, you have to put patients in froont of it, or you don't get your money back. what does it do? >> it delivers a focused beam of radiation to a target. regardless of motion and all that's going around with lungs going up and down. any kind of body movements. it's a very, very precise way to deliver radiation. and yes, we don't utilize the machine to pay for the machine.
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but we do pay for the machine by utilizing it. if that makes sense. >> did you have to buy this machine on time? or did you pay cash for it? >> well, we usually pay cash. >> is that where your profit comes into the picture? >> exactly. >> and what would have gone through the board's decision on something like this, to bring it in here, what would be the reason? >> we do a needs' assessment. we looked at the technology and compared to other technology. and at the time we were recruiting a couple of world-class radologists that are here, and they believed in the technology. we believed as a board, that this would put us in the
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forefront of patient care in that area of radiation oncology. that was the prime reason we decided to do it. we did have a business plan that predicted, i can't remember the detail. but how many years it would take to pay for itself. we try not to do things that are going to lose money over the time. we lose enough money just doing our routine taking care of patients. >> how much of the money you take in goes to patients and how much comes through donations to a community hospital? >> yeah, we don't get a lot of -- we have a foundation board that's pretty new. we were out of the fund-raising business for +q1a decade, we ar back in it now. and last year we raised about a
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million and half dollars, not a lot. we are hopeful that is going to grow. but in these economic times we have seen a downturn, and what people are able to do to support the hospital. >> how often is your hospital full? >> it's full a lot, i don't know the exact percentage. we try not to go to what is called re-route. but we have to do that several times a year, that's when the hospital is full at the seams, and we can't get a patient in. so they have to go to another hospital. >> from your experience, what motivates someone to have a not-for-profit hospital than a profit hospital, and which is better for the patient? better for the country? >> well, i think -- what motivates someone to have a
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for-profit is the profit. but i think not-for-profit is the best for the country. because i think it's cheaper. i think if not for profit hospitals can adopt some of the physical restraints that for-profit hospitals v -- have, it would be a valuable thing to do. but keep that savings as opposed to giving it to shareholders. but this hospital did a joint venture for two years ago with colubia hca, and during that time it was a valuable experience, we learned fiscal restraint that we still benefit from. because we save money in areas that normally we wouldn't have. but in a for-profit system that
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money goes to shareholders, in our system it goes back into had hospital. >> patients used to spend less times in the hospitals, in the old days you would be in for a week, what changed that? >> a lot of what happened, is that insurance companies at least with surgery, they charged things on what is called d.r.g. basis. you have a diagnosis, like pneumonia, and instead of paying you piecemeal, they pay a lump sum for pneumonia. when that happened there used to be pressure on the physician to get the patient out of the hospital sooner. because the sooner the patient got out of the hospital, the less money that would be spent. right.
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if the patient stayed in the hospital an extra two days, then any part of the profit that might be present would be dissipated. >> is that good or bad in your opinion? >> i think it's good, it has been good. >> so we didn't need to spend all that time in the hospital. >> a lot of time you don't know what you can get away from until you are pushed to do so. in cardiac surgery, we kept the patients in for eight days. and had something state of the art, and now we get patients out in three or four days. and quite honestly, a lot of that was pushed from limited reimbursement. and if you want to have a successful cardiac surgery
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program, you can't spend all the money. you got to have a lot of money left over to buy the equipment. so you have to be responsible. >> from your perspective, as you listen to this debate on health care, what is the worse thing you hear on a day-to-day basis, do you hear people =sin the town hall meetings or members of congress or wherever? >> i think the thing that scares me the most is the thought of the government having sort of a massive medicare or medicaid, and having all the inefficiencies that brings. and ending up with a system that is poor. a hospital system that's poor, and having no ability to offer really the best 8n(to our patie.
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that's what scares me the most. >> why would that happen in a medicare or single pair system? >> right now we lose 20% on medicare admissions. so if we lost 20% on everyone that came in, we would have to do something different. and as part administrator, the first thing i would do is limit our capital budget. so the new stuff that we buy every year, we buy $30 million of new equipment, that would have to stop. we would have to lay off people, we would have to make up that 20%. so the easiest way to make it up is to not buy new stuff. and that's what we do in our personal life, but when you talk about health care, new technology is expensive.
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and the people driving the new technology, expect a return on their investment. and if no one is buying it, it will just be a matter of time before no one is making it. no one is thinking about it. and that's a disaster for our health care. >> knowing what you know about hospitals and doctors, and operations, what would you tellc a patient coming in the door, they are afraid and coming in and with a heart problem, what should they do to give themselves a more peace of mind if possible? >> i am not sure, you know i think everybody needs insurance. if you don't have insurance, you need to get insurance. >> what if you can't afford it? >> well, i think -- i am not a
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politician, but there is something to be said about insurance reform and making insurance more competitive. so even people who don't have a lot of money, can have some insurance. what you don't want to happen -- everybody can get care. ok, you can get care. the problem is someone who doesn't make a lot of money, and doesn't have insurance, they are responsible to pay for the bill that got for that care. that's the problem. paying for it. you know the only person that ever asked me about how much something cost, is someone who has money but no insurance. they want to know what is it going to cost, because they have to write a check for it. and somehow we all need to feel some of the pain, other than
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writing a check for the insurance company. we need it feel that cost issue. >> there needs to be insurance reform, and everyone needs insurance, but i would start with trying to make more competition between insurance carriers, so there is affordable insurance. >> who is your biggest competition in the hospital business? >> you mean what other hospital? >> yeah, do you feel competition? >> absolutely, in our primary insurance carrier is anova, and they are our biggest competitor. >> so when you go home at
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night, you hook up with your wife, mary, a pediatrician, what is the difference in your lives, you are a heart surgeon, day in medicine, what is your two different perspectives? >> well, you know i am speaking for myself, i tend to feel more of a burden. i worry more. my wife has a lot of well-patients, well-babies. you know when she does have a sick child, she's totally worried at night. but that's not very typical. i think most pediatricians see well babies, and routine sort of stuff. and opposed to my practice, i frequently have patients that are pretty sick.
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and it's an inescapable burden, not that i run away from, it's and you know sometimes patients don't survive, and that's an awful, terrible struggle. that over the years get harder. because you have a sense that your ability should be so much greater than say it was 20 years. but we are not always successful. >> if you were to pass on, 11 years as chairman of board, if you were to pass on this job you have, in addition to being a heart surgeon, we only have two minutes, what would you tell the next chairman to worry about? >> i would tell the next chairman that regardless of -- i would tell the next chairman to worry about the system getting dumb-down and having it
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affect patient care. and i would encourage them not to do anything, anything that affected patient care. that made it mediocre, to keep an edge of pressure on the administration, on the board, to never cut corners. to never let this thing that we have built, where we give our patients the absolute best, don't let that change. and that's my biggest fear. because at the end the day, you got to pay. >> last question. if you weren't cardiac doctor, or heart surgeon, what would you be doing? >> i would be a chep. i -- chef, i would own a restaurant and work in my
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restaurant. and that's my second love. >> and your favorite food? >> probably italian, yeah. >> you finally smiled -- we are out of time. john garret, thank you very much. >> thank you brian. >> for a dvd copy of this program, call 1-877-662-7726. for free transcripts or to give us your comments about it program, visit us at q&a.org. "q & a" programs are also available at c-spanoipodcasts.
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>> dr. john garret featured on "q & a" will be involved on "washington journal" tomorrow, and we have a look at the health care system from the doctor's perspectives and hospitals. and for over three days, we will have them joining us and to take your phone calls and for the debate currently before congress. and we will continue
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parliament debates of the release of the lockerbie bomber, and then the canadian health care system, and fcc workshop on high-speed internet. as the debate over health care continues, c-span's health care hub is a resource, go online and watch the latest events including town hall meetings and share your thoughts. and including video from any town halls you have gone through. there is more at c-span.org/health care. the british house of commons in recess until october, with a return on wed.
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we will show debate release of pan am 103, with abdell baset ali al megrahi with this debate to release him to his home libya, the government's decision was defended and took opposition from leaders, this event is about an hour and 15 minutes. . business today which is a statement by the secretary of justice on the decision. this is of utmost seriousness. while today's business will be understandably emotional, we all have a part to play.

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